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Organization

SOVEREIGN BODY OF LOVE HEALING CENTER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LATRICE MARIE WADDELL MSN, PMHCNS-BC (ADVANCED PRACTICE REGISTERED NURSE)
(419) 508-9937
Entity
Organization

Contact information

Practice address
3409 N HOLLAND SYLVANIA RD, TOLEDO, OH 43615-1411
(567) 297-0008
Mailing address
1970 DEVINCI DR, TOLEDO, OH 43615-3373
(419) 508-9937

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
09/20/2024
Last updated
09/20/2024
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